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Journal Club: Preoperative Electrocardiograms

Journal Club: Preoperative Electrocardiograms. Troy Tada, DO August 26, 2009. End points of Study. Target patients who will likely have an EKG abn that would likely affect preoperative management Determine if age, alone, is predictive of significant abnormalities. Choice of article.

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Journal Club: Preoperative Electrocardiograms

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  1. Journal Club: Preoperative Electrocardiograms Troy Tada, DO August 26, 2009

  2. End points of Study • Target patients who will likely have an EKG abn that would likely affect preoperative management • Determine if age, alone, is predictive of significant abnormalities

  3. Choice of article • EKG utilitized on a daily basis • Improve criteria for preoperative EKG ordering • Ways how we can improve cost and resources

  4. Method • Weiner Center for Preoperative evaluation at Brigham and Women’s Hospital (Boston) • 1,149 EKG’s reviewed and interpreted by staff cardiologist • Pts with significant abn EKG were compared to a control group randomly selected from the remaining pts in the study • RF for each patient were listed

  5. Method • Significantly abn EKG • Census of anesthesiology and cardiology group in this study required further assessment of evaluation before preceding to surgery • Significant Q waves, major ST segment depression, major T wave changes, ST segment elevation, Morbitz type II or higher blockade, LBBB, and afib

  6. Results • Most common abn was minor T wave changes (186 pts, 16.2 % of EKG reviewed) • Most common significant abn was major T wave changes (57 pts, 5% of EKGs)

  7. Results

  8. Results

  9. Results • However, 5 pts (0.44%) in the significantly abn group were under 65 years of age and did not have any RF

  10. Bottom line • Independent RF increasing probability of having significantly abn EKG • High cholesterol • Age > 65 • Severe valvular dz, • MI • Angina • CHF

  11. Bottom line • EKG abn that should prompt the preoperative doc to request further info, consultation, or testing are controversial. • Variability based on physicians

  12. Limitation • Retrospective study • RF could have been further subdivided • No analysis of the subsequent impact of the clinician’s response t EKG on postoperative outcomes

  13. Open Discussion

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